Provider Demographics
NPI:1376509638
Name:RUB, JOSE M (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:M
Last Name:RUB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:MARK
Other - Last Name:RUB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:21110 BISCAYNE BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1228
Mailing Address - Country:US
Mailing Address - Phone:305-932-1007
Mailing Address - Fax:305-696-6225
Practice Address - Street 1:21110 BISCAYNE BLVD STE 106
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1228
Practice Address - Country:US
Practice Address - Phone:305-932-1007
Practice Address - Fax:305-696-6225
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54702208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1061221005OtherCIGNA
FL4113848OtherAETNA
FL1200282OtherUNITED MEDICAID
FL0000685OtherCIGNA 2
FL051963400Medicaid
FL000101139OtherHUMANA
FL002546OtherNHP
FL015064OtherAVMED
FL1202312OtherUNITED
FL09212OtherBCBS